This morning I was pondering the future of our healthcare system and the constantly changing and shifting world of healthcare reimbursement. Some observations are undeniable. Our current system is flawed and not sustainable. Something has to change.
As I look at all the changes happening in healthcare, I came to one major realization. Every program to reduce the cost of healthcare rests on the back of our ability to influence patients’ choices.
The future of health insurance companies hinges on their ability to change patients’ behavior. Looking at ACOs and MACRA, doctors reimbursement is going to be tied directly to the choices their patients make (or don’t make). Employers that are looking to lower their healthcare costs are going to invest in programs and technologies that ensure their patients are making healthy choices.
While many healthcare IT companies fall short of this goal, we do see some that are going to play a major role in influencing patient behavior. Take something as simple as a patient portal. Can access to your medical records influence your behaviors? Can access to your doctor or a nurse through a patient portal help influence the decisions you make? Absolutely. Do they go far enough? Absolutely not, but they’re a start.
Take a look at telemedicine. Will easy access to a doctor change our behavior? Could telemedicine mean that we choose to be seen by a doctor earlier as opposed to delaying a visit to the doctor because it’s too painful to schedule an appointment and go into the doctor? Absolutely. Plus, telemedicine is just one simple example of how we’re making a visit easier. Online self scheduling could influence this as well. A whole new wave of messaging apps and provider communities are forming which allow us to get “health care” remotely.
As I’ve written before, my fear is that most healthcare IT companies don’t go deep enough into the behavior change and instead focus mostly on process optimization. Behavior change is a surprising byproduct for some, but is certainly not their intention. In fact, that’s true for most of the examples I describe above.
It becomes more and more clear to me every day that the real breakout companies in healthcare are going to be those who figure out how to influence patients’ behavior. That includes influencing them the 98% (or whatever the correct stat is) of time that patients spend outside of the exam room. Every reimbursement effort is going to be focused around it.
The real challenge for these companies is going to be tracking and quantifying the value they created. It’s hard to track attribution when it comes to a patient’s health. It’s so complex that it’s easy to incorrectly assess who or what is responsible for a patient’s improved health. Plus, it’s extremely hard to quantify the benefit of these behavior changes. A company focuses on influencing patients’ behaviors is also going to have to get really good at tracking the benefit of that influence and attribution of what influenced the patient.
These are extremely challenging opportunities. Healthcare is full of them. I already see some companies heading down this path. I’m excited to see which ones really break through.